A proposed severity classification system for hepatolithiasis based on an analysis of prognostic factors in a Japanese patient cohort.

Abstract

Hepatolithiasis frequently results in severe complications. We conducted a cohort study to identify prognostic factors and to establish a hepatolithiasis severity classification system. The study cohort comprised 396 patients who were identified through a 1998 nationwide survey and followed up for 18years or until death. Cox regression analysis was used to identify prognostic factors. Median survival time of the patients was 308 (range 0-462) months. Of the 396 patients enrolled in the study, 118 (29.8%) died, most frequently from intrahepatic cholangiocarcinoma (25 patients, 21.2%). Age of≥65years at the time of initial diagnosis [hazard ratio (HR)3.410], jaundice for ≥ 1week during follow-up (HR2.442), intrahepatic cholangiocarcinoma (HR3.674), and liver cirrhosis (HR5.061) were shown to be significant risk factors for death from any therapeutic course. The data led to a 3-grade disease severity classification system that incorporates intrahepatic cholangiocarcinoma and liver cirrhosis as major factors and age of≥65years and jaundice for ≥ 1week during follow-up as minor factors. Survival rates differed significantly between grades. The proposed hepatolithiasis severity classification system can be used to assess prognosis and thereby improve patient outcomes.